Sorting out claims about healthcare legislation

Noam N. Levey

With lawmakers home for their August recess, a fierce battle has broken out over what precisely is in the mammoth healthcare bills being pushed by congressional Democrats. There has been no shortage of misinformation, much of it advanced by critics of President Obama's overhaul effort who have made sometimes outlandish claims. Here is a look at a few of the most contentious points.

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Does the legislation include provisions to encourage senior citizens to commit suicide?

No. This has become one of the most misleading, inflammatory claims made in the healthcare debate, advanced repeatedly by conservative commentators such as Rush Limbaugh and Sean Hannity and Republican lawmakers working to stoke fears among seniors.

Rep. Virginia Foxx (R-N.C.) recently suggested that the Democratic healthcare bill would "put seniors in a position of being put to death by their government." There is no such provision.

The House bill would give seniors on Medicare the choice to sit down with a doctor for an "advance care planning consultation" every five years to discuss options should they become seriously ill or unable to make medical decisions. Topics could include the development of a living will and directives for care.

"These are important discussions everyone should have so they are fully informed and can make their wishes known," Dr. J. James Rohack, president of the American Medical Assn., said in a statement. "That's not controversial. It's plain old-fashioned patient-centered care."

The provision is endorsed by the AARP.

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Would the government start paying for abortions?

That's unclear. Neither House nor Senate versions of the healthcare legislation contains any requirement that federal funding be made available for abortions. Claims that tax dollars will be used for abortions, as a television ad from the Family Research Council contends, are premature and somewhat misleading.

But the legislation is short on many details. Depending on how regulations are written, some women who got federally subsidized insurance might be able to buy plans that cover abortions.

Under the most popular Democratic proposals, millions of Americans would buy their insurance in a new, highly regulated marketplace in which private insurers and the government would offer a choice of health plans. Many of those people would qualify for federal aid to defray the cost of at least part of their premiums.

It appears unlikely that the government would require the plans in this marketplace to cover abortions. In fact, one version of the legislation explicitly prohibits such a requirement. But some private insurers in the exchange might cover abortion services. If a woman who received public subsidies for her coverage selected one of those plans, it could be argued that the government was helping to fund abortions.

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Would illegal immigrants get free healthcare benefits?

Provisions in the House and Senate bills explicitly prohibit people who are "not lawfully present in the United States" from getting federal aid to help them buy health insurance in the new exchanges.

Congressional Democrats have resisted Republican efforts to put tougher documentation requirements on those applying for aid, arguing that that could discourage many poor people from signing up for health insurance.

No matter what happens with the legislation, illegal immigrants would almost certainly still be able to get care in emergency rooms, a major burden in some parts of the country.

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Would the government ration care?

This is almost impossible to say, although if the legislation passes there may be less "rationing" than there is now.

Under the nation's current system, private insurers and the federal government put a variety of limits on what kinds of medical procedures, imaging and drugs they will pay for. Millions of people with preexisting conditions face even more limits, because private insurers refuse to sell them policies. A cornerstone of the Democratic healthcare overhaul is a larger role for the government in introducing more standards to regulate coverage and expand information about the most effective treatments.

Both House and Senate bills would prohibit insurers from denying coverage to anyone with a preexisting condition, thus eliminating one form of rationing in the current system.

The legislation also would give the federal government the authority to set minimum benefits levels that insurers would have to offer in order to sell policies in new exchanges. That could mean more coverage for millions of individuals and many small businesses that currently are shut out of the healthcare system.

Most controversial, the bills would fund more research into the comparative effectiveness of various drugs and medical procedures.

The legislation does not dictate that the research be used to limit coverage of any procedures. And many doctors and other healthcare experts see this kind of research as crucial to improving the quality of care. Nonetheless, some critics say the provisions someday could allow the government to use this research to limit what Medicare or other government insurance programs would cover.